THCB Spotlights: Glen Tullman, Executive Chairman of Livongo

Three Ways Doctors Can Use Patient Data to Get Better Results

Physicians have always been in the information business. We have kept records of patient data regarding the vital signs, allergies, illnesses, injuries, medications, and treatments for the patients we serve. We seek knowledge from other physicians, whether that knowledge comes from the conclusions of experts from research published in a medical journal or the specialist down the hall. However, a physician will always benefit from additional good information such as the analysis of pooled data from our peers treating similar patients or from the patients themselves.

Over the next few years, vast new pools of data regarding the physiologic status, behaviors, environment, and genomes of patients will create amazing new possibilities for both patients and care providers. Data will change our understanding of health and disease and provide a rich new resource to improve clinical care and maximize patient health and well-being.

Patient Data Used by the Patient

Instead of a periodic handful of test results and a smattering of annual measurements in a paper chart, healthdata will increasingly be something that is generated passively, day by day, as a byproduct of living our lives and providing care. Much of the data will be generated, shared, and used outside of the health system. It will belong to patients who will use it to manage their lives and help them select physicians and other healthcare professionals to guide them in their quest for a long and healthy life.

Based on a patient’s preferences and needs, the data will flow to those who can best assist them in maintaining their health. It will reveal important and illuminating patterns that were not previously apparent, and with the right system in place, it will trigger awareness and alerts for patients and other providers that will guide behaviors and decisions.

The future will mandate that healthcare systems have sophisticated analytical infrastructures in place to collect, analyze, and display these vast streams of data in ways that assist physicians and other care providers in delivering optimal care. Healthcare has always been dependent on managing information and knowledge to achieve the best possible outcomes, but this will become increasingly truer over the next decade.

Three Aspects of the Data-Driven Healthcare Transformation

This data-driven transformation will likely play out in at least three important ways.

1. Efficient and Effective Operations: Reduce Wasteful Spending

First, health systems will have to use data to run their operations more efficiently and effectively. Data can help healthcare providers better understand their operations. It can spotlight where they are wasting time, energy, and money. If an organization effectively uses information, it can optimize the use of resources, run more efficiently, and maximize reimbursement—all prerequisites for survival in the years ahead. While it sounds simple, this process alone promises to yield major efficiency gains and cost savings for organizations and for the nation. Experts have estimated that between 30 and 50 percent of healthcare expenditures in the United States are waste. Thus, this step alone represents a potential trillion-dollar opportunity to free precious resources for more productive use.

2. Manage Population Health
Second, data can help healthcare providers optimally manage population health. Data can be used to design more effective clinical processes that improve the diagnosis and treatment of the ill and injured. It can help physicians and other care providers understand how to standardize on evidence-based care processes. Standardization on a best practice represents significant additional opportunities to save costs and improve the quality and safety of care. Coupled with a physician’s knowledge and experience, data can augment a clinician’s ability to provide the best possible care.

3. New Technology-enabled Care and Personalized Medicine

Finally, new technology-enabled care delivery models will help healthcare providers deliver care that is more continuous, proactive, and geographically dispersed. Facilitated by the revolution in sensors, these care models will provide vast streams of data and turn society into an enormous learning laboratory. These sensors will provide information about what we do, how we eat, and when we exercise. They will provide information concerning our behaviors and our environments. In short, these new technologies will provide information regarding how we live in the real world and how our activities and environment impact health, disease, and treatments.

With the support of modern digital sensors, former trickles of information will turn into torrents creating vast pools of information that can provide new knowledge. In combination with genomic medicine, this new information will allow care providers to determine the right diet, medications, and therapies for each individual based on their specific situation, thereby delivering care that is far more personalized. And this type of personalized care will be empowering for patients and families, enabling them to participate in their healthmanagement in far more meaningful ways. The opportunities to improve population health are massive. Yes, there are significant issues regarding data security and privacy that must be addressed, but in time, they will be solved.

The Impact of New Data on Healthcare Costs

The impact of these trends on healthcare will be immense, to the point that it becomes hard to predict the ultimate impact on national healthcare expenditures. For years, healthcare policymakers and economists have been projecting massive increases in healthcare spending with each passing year. They correctly point out that this inexorable rise in healthcare costs poses an unacceptable risk to our economy.

While this is certainly of concern, the ultimate impact of aggressive waste elimination, process standardization, and new, more efficient, outpatient-centric care models is hard to quantify, yet it will likely be substantial. These powerful forces promise to drive healthcare expenditures down. As healthcare experiences the exponential impact of technological change, it is likely we will face a far different healthcare world a few years from now. Recall that not long ago we all relied on the thick Yellow Pages left on our doorsteps. Little did we know what impact a small company called Google would have on our lives.

Sooner or later, the same forces that have transformed other industries will fundamentally change healthcare. This will result in entirely new care environments and dynamics. This new world will most definitely revolve around data.

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Excellent comments on an article that demonstrates how egregiously people like Dr Houghon have strayed from the realities of what people want and how they think and how little they want us in their lives until THEY perceive that we are needed, and this is how it should be.

Dr. H and his well meaning kindred spirits are, sadly, the useful idiots of a healthcare industry that has become to health in the USA, what Goldman Sachs and B of A have become to your personal financial and banking interests.

EHR massive metadata is not to keep healthcare costs down, or improve quality or provide fast access to accurate answers to complex questions (It cannot do any of this) but as a tool to keep costs as high will be tolerated by an increasingly in-the-dark populace. And to keep you under the strictest control. Time does not permit enumeration of the myriad ways the likes of HCA, Blue Cross, Big Pharma and others coerce you and keep patients ignorant in the sophisticated quest for massive profit.

They know that (some of us) know this, so we are to be ever-more tightly controlled by the corporatocracy that is now siphoning off hundreds of billions of healthcare dollars, first out of people’s pockets and now from the treasury, leaving you with the tax bill. Recent fed budget approval of $457B to the healthcare insurance industry (not to actual care, but to the insurance industry). EHR metadata and surveillance is one more thinly disguised tool in this endeavor. Yammering on about quality and cost containment is just a diversion for the complacent.

The people most likely to read these blogs and comments are the healthcare industry themselves, in order to better devise ways to see that a recalcitrant minority of doctors who keep reminding us that the emperor has no clothes, never gain traction.

History shows we are not going to correct this. Dr. Houghon should read Etienne la Boetie’s “discourse on voluntary servitude” from the 1560s. It applies to him.

Great post. Unless you live without a smartphone or in a cave somewhere, it’s hard to argue that there’s already a ton o’ data about most aspects of our lives. It’s no longer a question of if we will create untold terabytes of data about most aspects of our lives. The question is instead can we manage our individual ever growing datasets–and even more importantly can we get to these data to turn that resource into useful information that helps us improve our own health or the health of our communities? The vision in the post is great–but there’s a little bit of a “then magic happens” moment. In order to protect and make data for health accessible, we need a health data infrastructure. (See prior post, “Health Data Outside the Doctor’s Office”). In fact it’s not going to be magic–it’s going be be hard work by many–much like creating the Internet, itself.

The problem is that the data will come before we have proof that it is useful. What will I do when a parent has an otoscope and diagnoses their child with otitis media? Much (probably most) of the OM probably went undiagnosed and resolved on its own, but now we are pressured to use antibiotics. The structure of the system receiving that data is critical in using it wisely. If a system is about identifying problems (like otitis in an asymptomatic child) and finding treatments (antibiotics when it wouldn’t otherwise be used), then this will simply add expense and even risk. If a system is instead about reducing risk and improving quality of life (avoiding problems), then there will be pressure to find data that is truly useful in meeting that end. I do Google spreadsheets on multiple patients for their blood pressures and glucose measurements, allowing me to give them advice at the time of the problem and keep small problems from becoming larger). I agree with John that it’s not about good data/bad data. We need to collect data with a purpose in mind, not just data for data’s sake. This is what worries me about many of the new wearable technologies. Is this really data that will help people, or will it just add to the noise?

Basically what the author is saying is that we are going to have a ton of information and if we know what to do with it we could make healthcare in to a lean, mean health-enhancing machine. Information could be the next revolution.

My guess is that fusing genomic information with administrative data bases will empower insurers to make rational decisions and deliver high value patient-centered care that is predictive, participatory and personalized.

I do much prefer Google to the old yellow pages. But Google doesn’t spew torrents of data at me; the beauty of Google is that data emerges when I query for it. I also don’t have to hassle anyone to get their data into Google so that I can query it.

When a patient comes to me and says “I can’t sleep” I would love to have an easy place to query and get their sleep data. (Next best: prescribing sleep tracking, without wading into the weeds of which app or having to set it up for the patient.) Actually, I would also like to have access to the evals done by other providers, so I can make sure it’s not sleep apnea or CHF or some other problem someone else has already started identifying. (Some patients seem to think we have xray vision and know everything that has happened with other providers.) We are already bad at managing the data we have; is this the moment to add lots more data to the mix?

Anyway, this post is high on optimism and low on the many roadblocks we currently face.

In general, I think doctors are used to doing the 20% that we think gets the most important 80% of the work done. Everyone is offering us more data, so we can address the 80% extra work. It could improve outcomes, but it will definitely increase work (read: expenses) and we currently face serious hazards related to data overwhelm.

The overwhelming majority of Americans are low-risk and don’t need their doctor to help them understand that.

High-risk people need good medical management. Oh, I’m sorry, isn’t that what the medical industry has been doing for the last 50 years? Managed care? Disease management? The trusty, Swiss-Army-Knife general internist? They’ve all just been sitting on their hands, but now through the magic of data and tracking, they can save everyone? WOW. I’m so underwhelmed.

“The opportunities to improve population health are massive.” Those aren’t the words of someone looking to focus on high-risk people.

Bobby, of course, I want guidance on how to eat, exercise, sleep, have sex, etc. from a class of professionals who will expect my insurer to pay for it and who have no particular expertise to dispense. Most studies of healthcare professionals’ lifestyle habits show that they are little better than the general population. I have never met a single physician from whom I learned a single thing about nutrition or exercise.

It’s ironic that people in white coats with stethoscopes apparently can’t hear. Most people do not want you in their lives. You are a fixer, a mechanic, a technician. When something breaks, I’ll come see you. Otherwise, leave me the heck alone and try to restrain your manifest pomposity about being able to “fix” me based on your dredging of big data.

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